Nachsorge nach Nierentransplantation – Welche Immunsuppression ist für welche Patienten im Langzeitverlauf geeignet?

Die Wahl der Immunsuppression im Langzeitverlauf nach Nierentransplantation ist nach wie vor eine Herausforderung für jeden Nephrologen. Nach dem Beginn mit einer Tripelimmunsuppression bestehend aus einem Calcineurininhibitor, Mycophenolsäure und Steroiden ohne oder mit zusätzlicher Induktionstherapie gibt es viele Gründe für eine Modifikation der eingesetzten Medikamente. Dazu gehören eine Über- oder Unterimmunsuppression, die zu Korrekturen führen muss. Nicht selten zwingen aber Nebenwirkungen der Medikamente selbst, Infekte oder das Auftreten von Antikörpern zu einer Veränderung der Therapie. Ziel bleibt immer die Gesamtmenge der Immunsuppression möglichst niedrig zu halten, was aber in Zeiten komplexerer Patienten mit jetzt häufigerem Auftreten von Antikörpern und auch z. T. schlechterer Organangebote nicht immer gelingen kann.

Today, immunosuppressive therapy in the long-term after kidney transplantation is influenced by many factors. Starting with a triple therapy including calcineurin inhibitors, mycophenol acid and steroids with or without induction therapy, many patients need an adjustment of their immunosuppressive drugs. Adverse events, infections or antibodies before and after transplantation lead to specific changes of the drug therapy. Nevertheless, the main aim is to reduce immunosuppression to a level as low as possible. Unfortunately, older organs and patients' history sometimes are limitations for this step.

Key words

renal transplantation - follow-up care - immunosuppression - long-term follow-up - modification

• Literatur

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